title: Pilot study comparing the two hemostatic agents in patients undergoing partial nephrectomy.
abstract: BACKGROUND
  Recently studies have demonstrated improved outcomes in patients undergoing nephron-sparing surgery (NSS) for low stage renal tumors, thus NSS is widely accepted as the treatment option for these patients. With NSS, there is a risk of renal hemorrhage and thus haemostatic agents may be routinely applied to the cut surface of the kidney. Herein we compare two commercially available haemostatic agents applied intra-operatively to the cut surface of the kidney. Post-operative outcomes (oncologic and non-oncologic) are reported.
  
  
  METHODS
  The medical records of 23 patients with suspicious renal mass documented on axial imaging and who underwent open NSS via a mini-subcostal incision were extensively reviewed. One of two haemostatic agents (Floseal®, n = 11; Arista®, n = 12) was intra-operatively applied to the cut surface of the kidney. Chi-square and T- student test was used to compare outcomes between the cohort of 11 patients who had Floseal® and the 12 patients who had Arista®.
  
  
  RESULTS
  Median pre-operative size of renal mass was 4.3 cm (range 1.5-7.0 cm). Final pathology revealed 3 oncocytomas and 20 renal cell carcinoma (17 clear cell, 1 chromophobe and 2 papillary), pT1a = 14 and pT1b = 6. Mean intra-operative blood loss and hospital stay between the Floseal®vs. Arista® cohorts did not significantly differ (227 mL vs. 250 mL, p = 0.68 and 4.4 days vs. 4.5 days, p = 0.76, respectively). Intra-operative and post-operative complications were not different between the two cohorts. No recurrences have been documented with a mean follow-up of 18 months.
  
  
  CONCLUSIONS
  Along with meticulous surgical technique, the use of either haemostatic agent (Floseal® or Arista®) was not associated with high rate of intra-operative or post-operative haemorrhage. Thus either haemostatic agent may be successfully used during NSS.
authors.affiliation: Section of Urologic Oncology, MD Anderson Cancer Center Orlando, Orlando, FL 32806, USA. deacdoc@aol.com.
authors.forename: Diego Aguilar
authors.initials: DA
authors.lastname: Palacios
authors.forename: Michael
authors.initials: M
authors.lastname: McDonald
authors.forename: Makito
authors.initials: M
authors.lastname: Miyake
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Rosser
mesh_terms: D003710:Demography; D005260:Female; D006490:Hemostatics / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D059351:Organ Sparing Treatments / Q000009:adverse effects; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics